Bills would allow part-time ER

June 18, 2013

SARANAC LAKE - Legislation has been proposed in Albany that would let Adirondack Health run a part-time, off-campus emergency room in Lake Placid - possibly a compromise between a hospital looking to cut costs and a community wanting to keep its ER.

The state nurses' association, however, condemned the proposal Monday.

Companion bills were introduced last week in the Senate by Sen. Betty Little, R-Queensbury, and in the Assembly by Assemblyman Dan Stec, R-Queensbury. If approved, they would amend state Public Health Law to create the "Lake Placid Part-Time Off-Campus Emergency Department Demonstration Program."

Stec told the Enterprise that the bill is "a reasonable compromise to save some level of emergency care in Lake Placid, at least for the short-term, until maybe a better long-term solution is found."

The legislation comes as Adirondack Health has been pushing a controversial plan to convert the around-the-clock emergency room at Adirondack Medical Center-Lake Placid to a 12- or 16-hour urgent care center. The proposal has drawn fierce criticism in Lake Placid and surrounding communities, with many saying it would threaten their safety and hurt local ambulance squads. At a meeting in late May, Adirondack Health's Board of Trustees postponed a decision on it for at least 60 days, saying it planned to study the proposal further and get additional community input.

The bills proposed in Albany would address some of the concerns that have been raised about converting the ER to an urgent care clinic. Among other things, ambulance squads have said they can't bill patients' insurance companies if they take them to an urgent care center. Critics have also said an urgent care center isn't required to have as many staff on hand as an emergency department. Some have also noted that urgent care centers aren't governed by a federal law that requires emergency departments to treat every patient, regardless of their ability to pay, whether through their health insurance or out-of-pocket.

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Adirondack Health officials have said the volume of patients at the Lake Placid ER doesn't justify keeping it open 24 hours a day. The pending legislation would let the organization reduce the Lake Placid ER's hours, relocate it anywhere in the town of North Elba and still have a certified emergency department. Hospital officials have talked about consolidating all their Lake Placid facilities on the Uihlein Living Center nursing home campus.

"They could convert to an urgent care facility, but it's not the same as an emergency room," Little's spokesman, Dan Mac Entee, told the Enterprise. "In order to operate an emergency room part-time, state authorization is required."

The legislation would authorize the state health commissioner to let Adirondack Health operate a part-time, off-campus emergency department that would have to be open at least 12 hours a day, each day of the year. Mac Entee said the hours could be expanded when there are big events in the community.

The legislation says the part-time ER would have to meet federal Medicare and Medicaid requirements for a "provider-based off-campus emergency department as well as those requirements established by the commissioner for emergency services provided by general hospitals." The commissioner would waive any requirements "that cannot be reasonably applied to an off-campus part-time emergency department."

Within 18 months of when the legislation takes effect, the health commissioner would have to submit a report to the governor and the Legislature on the effectiveness of the demonstration project and whether such a model could work in other parts of the state. The amendment would expire five years after it takes effect.

Mac Entee said the legislation was an outgrowth of a recent rural health conference in Albany that focused on the financial challenges faced by rural hospitals.

"The conference was an opportunity to discuss these kinds of issues, and this is one that came up," he said. "Operating an emergency room part-time would provide some savings to the hospital but also provide for a level of care that people in Lake Placid are interested in seeing."

"It's important to the community there to maintain as much of the status quo as possible," Stec said. "There's a big difference between a half-time emergency room and a half-time urgent care center."

Adirondack Health officials didn't have much to say Monday about the pending Senate and Assembly legislation.

"We're looking at all options in regard to the Lake Placid ER, and it would be premature to report on any results or speculate on that bill," said Adirondack Health spokeswoman Hannah Hanford. She declined to talk more specifically about why the legislation is being pursued. A message left Monday for Stan Urban, chairman of Adirondack Health's board, hadn't been returned as of press time.

The New York State Nurses Association, which has lobbied against the proposed conversion of the Lake Placid ER, issued a statement Monday calling this latest proposal "misguided" and one that was put forward without any public discussion.

"The bill, S-5764, would limit life-saving, emergency care to the residents and visitors of Lake Placid and other High Peaks communities and put increased pressure on EMS services in Lake Placid, Keene, and Wilmington towns," NYSNA's statement reads. "Emergency departments are akin to police and fire departments and cannot meet the public's needs or expectations if operated on a part-time basis. Medical emergencies do not follow a clock and will occur when the ED is closed, unnecessarily threatening lives. Longer trips to more distant emergency departments can be the difference between life and death."

Mac Entee said converting the Lake Placid ER to part-time may not be ideal, "but there's also, I think, a recognition by a lot of folks that giving the changing nature of health care and the financial challenges Adirondack Medical Center faces, as well as other hospitals, that there's a need sometimes to make an adjustment that is less than ideal but better than the alternative, which is the urgent care facility."

The Senate and Assembly bills have been referred to each chamber's health committee. The current legislative session is scheduled to conclude Thursday, but both Mac Entee and Stec said they're optimistic the bills could be approved by then.

Stec said the fact that it's a demonstration project that will expire in five years gives the legislation a better chance of getting passed.